Individual
DR. JOHN M PORTERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1175 S MAIN ST, GREENVILLE, MS 38701-6337
(662) 335-5872
(662) 335-2677
Mailing address
1175 S MAIN ST, GREENVILLE, MS 38701-6337
(662) 335-5872
(662) 335-2677
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
80037
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00111482
—
MS
01
—
480017850
PALMETTO GBA-RR MEDICARE
MS
Enumeration date
08/31/2006
Last updated
07/08/2013
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